Patella Femoral Pain Syndrome, also known as PFPS or Runner’s Knee or Jumper’s Knee, is an umbrella term used for pain that’s present around patellofemoral joint (the joint between the kneecap and femur). PFPS is a chronic condition that tends to be worse with overload repetitive activities like squatting, running, and stairs. PFPS can be brought on overtime or acutely, depending on the activity. PFPS can also happen to anyone however it tends to occur in those that have had a rapid increase in load of their patellofemoral joint. Therefore, this can range from those who’ve started running, joined a new gym class, doing more bushwalks, moved house and there are stairs, new job that required walking, or even start social salsa dancing at the local club.

As PFPS is the term used to describe pain in the patellofemoral joint, that therefore means that the cause can be anything that can influence this joint, making it a multifactorial cause. Some of the causes can include:

• Overuse or Overload: As mentioned above, when there is a rapid increase in the use of the patellofemoral joint, this in turn applies increase load especially onto the patella tendon. When the tendon is overloaded/overused, the tendon becomes inflamed and can result pain or restriction of the patella tendon and distal quadriceps.
• Anatomical or Biomechanical Abnormalities: How the patella bone aligns and orientates can greatly influence the pressures that are place on the patella and surround structures themselves. If the patella is in an abnormal position, it can lead to muscular imbalances and biomechanical changes that can result in pain, discomfort and irritation.  
• Muscle Weakness: Of the lower limb muscles, the quadriceps has the most influence of the patella as the distal tendon runs over the top of the patella itself. If the muscle is weak, it may cause the patella to move in an abnormal way causing irritation. In addition to the quadriceps, weakness in the hamstrings, calves and glutes can lead to imbalances and biomechanical changes such as a change in the knee angle and forced overuse of other muscles.
• Muscle Tightness: Like muscle weakness, muscles that are tight can also lead to imbalances and biomechanical changes of the patellofemoral joint; as well as influence the orientation and alignment of the patella.
• Patella Trauma: A history of patella fractures, patella dislocations, lower limb muscle tears directly impacts the patellofemoral joint.

As PFPS is an umbrella term used for patellofemoral knee pain, it is ultimately diagnosed utilising a ruling-out method where all other possible pathologies are excluded. Generally, the diagnostic criteria are: 1. Prescence of retro or peripatellar knee pain 2. Reproduction of pain during squatting or other movements that involves the patellofemoral joint 3. All other conditions that can cause knee pain are excluded.

In most cases, imaging is not required as it does not change the course of treatment and diagnosis can be made by the clinical presentation.

During the initial assessment, a thorough subjective assessment will be completed which can help streamline the objective assessment. This will also identify the potential factors and causes of PFPS. After that, the objective assessment will look at the following:

• Observe your walking pattern
• Feel for tenderness around the knee
• Assess the range of motion of the knee and hip
• Assess the strength on the quadriceps, hamstrings, calves and glutes
• Feel for any tightness
• Assess the single leg stance
• Assess function such as stairs, squatting, crouching, running.

Most patients improve over time with conservative management. However, if the pain does not improve, the following medical management can be done:

• Pharmacology/medications: types of medications than can help include anti-inflammatories and/or analgesics.
• Surgery: If there is a history of subluxing or dislocating knees, then a review with an orthopaedic surgeon may be required. Additionally, if there has been a history of trauma.

Most patients improve over time with conservative management. However, if the pain does not improve, the following medical management can be done:

• Pharmacology/medications: types of medications than can help include anti-inflammatories and/or analgesics.
• Injections: Corticosteroid Injections can be used to reduce inflammation and swelling. More invasive measure like nerve blockers can be used if the case is complex.
• Surgery: Carpal Tunnel Release Surgery is the process where a surgeon cuts the ligament pressing on the median nerve. This can be done through open surgery or endoscopic surgery.

Physiotherapy plays a crucial role in the conservative management of PFPS. Based on the subjective and objective assessment, your physiotherapist will be able to determine the best treatment plan. Here’s how it can help:

• Pain Management
  • Manual Therapy: Massage or releases can help reduce pain, improve blood circulation to the affected area and release any tension of muscles to provide effective short-term relief.
  • Taping: Taping can help unload the structures around the knee and surrounding areas.
  • Heat/Cold: Using heat or cold can provide short term relief and assist in reducing inflammation.
• Stretching and Strengthening Exercises
  • Stretching: Stretching and releasing of muscles and structures can help improve the flexibility and muscle length of the muscles area the knee especially the quadriceps.
  • Strengthening: An appropriate strengthening program is important to complete as this will improve the strength and endurance of the muscles including lower back, glutes and legs.
  • Functional exercises: These will include squat variations, lunges, jumping variations, task or sport specific exercises and hydrotherapy.
• Education
  • Understanding the cause of PFPS, how to treat it and what to expect from your rehabilitation will improve the overall outcome and give you a sense of autonomy. Your physiotherapist will help explain the condition and prognosis. And there is no such thing as a silly question!
• Activity Modifications

During the rehabilitation, you made need to adjust your daily activities and exercising to avoid flaring the injury. Activity modifications can include frequency and duration of breaks, adaptations of techniques, and a gradual return to activity. Additionally, postural guidance or lifting techniques will be reviewed to ensure proper form is used.

PFPS can be a frustrating condition, impacting everyday life. However, as PFPS is generally due to an impairment of a structure around the knee, that means that it can be worked on and is not a permanent injury! So, with the right diagnosis and physiotherapy treatment, you can manage the pain and get back to your normal activities. Remember, early intervention is key to preventing serious or chronic problems.

If you or someone you know is struggling with PFPS, contact us today to schedule a comprehensive assessment and personalised treatment plan.

Our experienced physiotherapists are here to help you recover quickly and prevent future injuries.

Call us now on (02) 4721 1222 or book an appointment online.